Influence of jejunal morphology changes on exocrine pancreatic function inceliac disease

Background: Concurrent exocrine pancreatic dysfunction may be one of the fa ctors implicated in malabsorption in untreated celiac disease, as shown by studies on bicarbonate and pancreatic enzyme secretion. The purpose of this study was to evaluate exocrine pancreatic function in relation to jejunal morphology in celiac disease. Methods: Thirty-six patients fulfilling the ESPGHAN criteria for celiac dis ease, aged 3 to 18 years and 36 control subjects matched for age and sex we re investigated. The design of the study included measurement of serum panc reatic isoamylase by a chromogenic method after selective inhibition of sia lic isoamylase in the untreated phase in patients consuming a gluten-contai ning diet and after gluten elimination for a period of 1 year; fecal human elastase activity determined by enzyme-linked immunosorbent as say in patie nts consuming a gluten-free diet and again after gluten challenge for 6 mon ths correlation of serum pancreatic isoamylase and fecal elastase to the je junal morphology, classified by criteria described by Marsch; the enzymes i n the control group; and ultrasonography of the pancreas in both groups. Results: Enzyme values obtained from celiac disease patients with normal mu cosa were significantly higher than those obtained from patients with villo us atrophy (p < 0.001) and comparable to those obtained from the control gr oup. Serum pancreatic isoamylase activity increased to normal after gluten elimination, and human elastase activity decreased to values below 200 mu g /g of stool after gluten challenge. Enzyme activity was related inversely t o the degree of intestinal damage. The echogenicity of the pancreas was nor mal, regardless of enzyme activity or gut morphology. Conclusions: Exocrine pancreatic function is abnormal in celiac disease whe n mucosal atrophy is present. Exocrine pancreatic function parameters are a ssociated with the changes of intestinal mucosal morphology in three consec utive phases of the disease.